The purpose of this project is to determine the incidence rates, rates of progression, and risk factors for the chronic complications of type 2 diabetes. The study is conducted in the Pima Indians of the Gila River Indian Community, who have participated in a longitudinal epidemiologic study since 1965 (see project Z01 DK 69000). Risk factors for the major complications of diabetes, retinopathy, nephropathy, and coronary artery disease, are determined by longitudinal follow-up of diabetic subjects. Methods of ascertainment of these complications include fundus photography, measurement of urine albumin and serum creatinine concentrations, and electrocardiography. Results of a segregation analysis suggest a major effect of a single gene on risk of nephropathy as a function of duration of diabetes. The group is taking part in a multicentered genetic linkage study (Family Investigation of Nephropathy and Diabetes) of diabetic nephropathy in an attempt to identify such a susceptibility gene.